Research on COVID-19, the cause of a rapidly worsening pandemic, has led to the observation of laboratory derangements such as a propensity towards a hypercoagulable state. However, there are currently no reports on the incidence of pulmonary venous thrombosis in the setting of COVID-19. We report a case in which follow-up chest CT scans revealed an expansile filling defect in a branch of the right inferior pulmonary vein, which is consistent with pulmonary venous thrombosis. Our objective was to provide insight into an uncommon sequela of COVID-19 and consequently garner increased clinical suspicion for pulmonary VTE during hospitalization.

2627 Background: There are increasing reports of thromboembolic complications in patients with COVID-19 infection. According to a meta-analysis of 28,173 patients, the prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients ranges from 7.9% to 22.7% based on the severity of COVID-19. Cancer and anti-cancer therapies are known risk factors for thrombosis. Another study based on registry data reported the overall prevalence of VTE in hospitalized COVID-19 patients with cancer to be 14.5%. Our study aimed to assess the prevalence of VTE in cancer patients diagnosed with COVID-19 as well as the association between VTE and cancer in the setting of COVID-19 infection in a large predominantly urban healthcare system. Methods: We utilized a cohort data query tool in the electronic medical record at University Medical Center in New Orleans, Louisiana to identify patients >17 years of age with a hospital or clinic visit in the LCMC Health system between March 1, 2020 and December 31, 2020 which were considered the base population for the study. Cancer patients were identified via the cancer registry tool. Patients with COVID-19 were identified using the abnormal COVID-19 PCR test result search field. An encounter diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) was used to identify patients with VTE. Odds ratios, p-values, and corresponding confidence intervals (CI) were calculated using 2x2 contingency tables. Results: In our database, we identified 3,807 patients with a diagnosis of COVID-19 and 9,560 with a cancer diagnosis. 158,812 patients had neither COVID-19 nor cancer. There were statistically significant greater odds of developing VTE in all subgroups compared: COVID-19 alone vs neither (OR 2.43), cancer alone vs neither (OR 3.8), and COVID-19 and cancer vs neither (OR 10.65). Conclusions: COVID-19 and cancer are both risk factors for VTE. Based on our study, appears that cancer has the greater effect on VTE compared with COVID-19 infection. Also, there is possibly a synergistic effect between COVID-19 and cancer, which further increases the likelihood of VTE. This study is a preliminary analysis. Further investigation is warranted in the form of either variable adjusted analysis of the same data, individual chart review, or a prospective study.[Table: see text]

A diagnostic challenge arises when a patient presents with a ring-enhancing lesion of the brain in the setting of both metastatic cancer and a source of infection. We report a case depicting this dilemma in an 80-year-old man with a history of metastatic oral squamous cell carcinoma who presented for left-sided hemiparesis. Computed tomography and magnetic resonance imaging revealed a ring-enhancing lesion of the right parietal vertex without signs of stroke. He was also found to have an aneurysm of the right common carotid artery with abnormal surrounding soft tissue density and gas, findings suspicious for a mycotic aneurysm. The likelihood of the brain lesion being an abscess formed by septic embolization was raised, leading to the recommendation to surgically explore the brain lesion and repair the aneurysm. Nevertheless, a high index of suspicion for a brain abscess and mycotic aneurysm is necessary in this type of clinical scenario.